UMD DEPT HPER RISK ASSESSMENT FORM - complete this form and be familiar with its content for every off-campus program.
Program/Activity Name:_ND Badlands Leadership Trip - South Unit______Location: __Medora, ND______Date or Season: _May 17-25, 2010

Potential accident, injury, or other damage which may occur: / Backpack related injuries/illness: blisters; ankle twists; toe-nails; knee injury
Dehydration; Severe sunburn; tick-bite reaction; Poison-Ivy; Bison charge; Rattlesnake bite
People: / Equipment: / Environmental:
Potential causes for the above: / Lack of conditioning; inadequate and/or new equipment; Inattentiveness - both to hydration, sun protection, and surprising wildlife
Denial of previous illness/injury and/or equipment deficiency
/ Poor Quality and/or condition
New and not adequately broken in
Wrong equipment: Shoes, socks, pack
Van &/or Trailer problems (e.g., brakes, wheel bearings on trailer) / Sun, Poison Ivy, Ticks, Bison, Slippery terrain in rain (ND Bentonite Clay), Getting too close to wild horses - Bison, Rattlers, and Horses are unlikely problems, but can result in severe injury if an encounter occurs.
Strategies for reducing the potential risk: / Adequate instruction, pre-trip planning, reading of health forms, and clear description of terrain.
Also, instructors must use good judgement in screening participants for fitness and ability (which includes a need for at least intermediate back camping skills).
/ Review and assess equipment prior to trip departure.
For all risk factors, be prepared to alter route to accommodate deficiencies. The Badlands are excellent for this because there are an abundance of very reasonable alternate routes. / The environment is the greatest risk factor because people who are unfamiliar with this area tend to underestimate the potential for injury. Understanding wildlife behavior is essential in this area.
Strategies for dealing with emergencies (including emergency contacts and access points): / Proper instructor selection and familiarity with the area. Proper instructor supervision and education about wildlife habits (where an encounter is likely and how to behave when an encounter occurs)
Have 1st aid kit
Include Cell Phone in Van
Emergency Contacts: NPS: South Unit (701) 623-4466 (Primary park phone number)
Nearest Hospital: Dickinson:Great Plains Clinic,
33 9th St W, Dickinson, ND 58601
(701) 225-6017
Course instructor cell phone#:
Recommended Policies/guidelines / Proper instructor selection - prairie/badlands familiarity, backpacking skills, wildlife (large ungulate & reptile) behavior/natural history, and safety associated with arid regions.
Skills needed by staff: / See above - and refer to Ken Gilbertson for travel to this area.


Completed by: __Ken Gilbertson______Date: _5-10-2010_ Approval: Your supervisor ______
FORM MUST BE APPROVED BEFORE PROGRAM/ACTIVITY CAN OCCUR
∗ One hard copy goes on file with Janice Hilger, computer file goes to Ken